Sunday Dialogue: Our Notions of Gender

In March, you reported on 6-year-old Coy Mathis, born a boy and now identifying as a girl. Although her school in Colorado first allowed her to use the girls’ bathroom, one day she could no longer do so. The state’s civil rights division has now ruled against the school, rejecting its argument that “as Coy grows older and his male genitals develop along with the rest of his body, at least some parents and students are likely to become uncomfortable” (my italics).

Actually, no one knows whether Coy will continue to feel that she is a girl when her body develops further, since most children like her grow up to be gay, not transgender.

Gender identity is one’s sense of being a boy or girl, man or woman. Theories abound, but no one knows how it develops in transgender or non-transgender people. Some children strongly disagree with their gender assignment as young as age 2. Clinicians call this gender dysphoria. It is rare, and most gay people were not gender dysphoric as kids.

Some clinicians encourage early social transition, without surgery or medication, to the other gender. This approach implicitly assumes a trans-adult outcome or a benign transition back to the original gender. But little research has been done on these outcomes.

Other clinicians discourage any cross-gender behavior. They believe, also without much empirical proof, that early social transition encourages gender dysphoria persisting into adulthood and a lifetime of medical treatment for gender reassignment.

A third, “wait and see” approach permits cross-gender behavior but sets no goal for the child’s final gender identity.

I would advise parents to learn all they can about the different approaches so they can understand the limitations and how they are sometimes guided by personal beliefs about gender rather than by good research data.

JACK DRESCHER New York, June 25, 2013

The writer, a psychiatrist and psychoanalyst, served on the D.S.M.-5 Work Group on Sexual and Gender Identity Disorders. He is co-editor of “Treating Transgender Children and Adolescents.”

Readers React

I empathize with children’s need to be true to themselves. But when I hear 3-year-olds, who are famous for their fluid sense of fact, fantasy and fiction, being dubbed transgender, I worry that parents and doctors may be imposing the trans label on children to allay their own anxieties about gender expression (boys in tutus and so on). They feel compelled to locate children who are exploring possibilities of gender firmly on one side or the other of the gender binary.

If a 3-year-old says she’s a chicken, that doesn’t mean you should start feeding her kernels of corn — or that you should diagnose “chicken identity disorder.”

Gender-nonconforming children need time to freely, safely discover who they are. Many grow up into happily gender-conforming adults. Some grow up to be transgender adults, but most transgender adults aren’t transsexuals whose lives depend on gender reassignment: many are cross-dressers, gender fluid or gender queer. It takes years to sort out identities that don’t fit easily into socially recognized categories, and even children who are transgender may be harmed by the imposition of transsexual identities and therapies.

But because we live in a world still organized in terms of the gender binary, it’s hard to create spaces in which our children can safely explore nonconforming gender identities. Parents who support their freedom of gender expression may face censure by families, shunning by neighbors and even state investigation of their fitness to be parents.

Despite these harsh realities, our job is to help our children discover and become their wholest, truest selves. Whether or not we support medical treatment for gender-nonconforming children, the usual rules apply: children need to know that they are seen, held and loved for who they are. They need a rich array of possibilities to play with and explore, and we need to be patient and loving as they do so.

JOY LADIN Hadley, Mass., June 26, 2013

The writer, a male-to-female transsexual, is the author of “Through the Door of Life: A Jewish Journey Between Genders.”

So, a 6-year-old has the entire state of Colorado’s school system in upheaval? Either Coy is one incredibly powerful first grader, or the educational system of Colorado is in serious need of repair.

As someone who uses public facilities with great frequency, I can tell you that it’s always been my practice to enter the bathroom, do what needed to be done with as much privacy as the setup allowed, and exit said washroom to carry on with my life. Whether those around me were girls, boys or folks who had yet to make up their minds had very little effect on my actions. And so, the question in my mind is: Why are we still enslaved by our shame of the human body?

Children see one another naked on the beach and in their homes all the time. They show no trauma or psychic wounds from the exposure. I’d argue that those who are raised without unnatural fear of the opposite sex grow up to be more secure and comfortable with one another and with their own bodies.

So I suggest, instead of demarcating restrooms by sex and causing all of these problems in Colorado, why not just place a giant fig leaf on the door to remind us that our maker didn’t plan on our covering ourselves up with shame.

HARVEY FIERSTEIN New York, June 26, 2013

The writer is the actor and playwright.

Since there is a lack of empirical evidence as to what approach to handling gender dysphoria has the best results, it seems difficult to know how best to address the issue. However, I find something troubling about the implied equivalency of the three approaches.

As a transgender woman who grew up repressing myself into a male identity even though I experienced gender dysphoria from a young age, I face a lot of difficulty in my current life that I might not have if I had been able to socially transition at a younger age.

I believe that a more open discussion about gender identity, and treating gender as a more fluid and less binary system, does a service to people as a whole. Any approach that creates rigid expectations of the future of an individual’s gender does not capture the reality of the current gender discourse.

Likewise any approach that places hard limits on the behavior of a child seems to fail in a genuine way to embrace gender as it occurs in the actual world. Some children will wear dresses and play in the mud, others will wear pants and cherish dolls. Explicitly gendering the behaviors of children seems to be a disservice to them.

GABRIELLE LEY Kingsport, Tenn., June 26, 2013

Dr. Drescher is correct — we lack the empirical data from valid research studies evaluating children to drive clinicians’ practice. But there has been a wealth of clinical experience over the past 50 years. The 97 percent success rate for adult transition was first ignored and then argued for decades.

Those who demand of parents that they reject their children’s demands to be seen for who they are have often been the ones most resistant to allowing adults to transition, instead offering all sorts of reparative therapy to prevent transition.

Bias against transgender and gender nonconforming people is profound. We don’t demand of people with any other condition that they jump through the hoops we impose for a gender transition.

The primary medical dictum is, “First, do no harm.” A half-century of lived and clinical experience has proved that trans people, including children, should have the right to self-determination. Denying that right is ethically wrong.

Photo

Credit
Loren Capelli

And if a child grows up and decides to detransition, then what of it? The harm done is minimal, compared with denying a child the love and affection associated with encouragement of self-determination.

DANA BEYER Chevy Chase, Md., June 26, 2013

The writer, a retired surgeon, is executive director of Gender Rights Maryland.

Having grown up in the 1950s and ’60s when this subject was never openly discussed, I can only wonder what my life would have been like if I had been allowed to choose! Sixty years of coping and study, and still I have no answers if I have lived my life correctly. Through the many lifestyle purges and attempts to change, I have continued to live with my alternate life. “She” is always with me, attempting to speak, but always very quietly lest “she” be noticed.

I have allowed “her” to remain exposed as long as a week, but generally for no more than a few hours. Frustration and a lack of true commitment are the result.

I can only ask the same questions Coy’s parents must have asked many times.

Will she change her mind when puberty hits? (My experience was a definite no.)

Will she be allowed to change back and forth as she matures and discovers herself? (Probably not.)

How will her friends and classmates react to her? (With contempt and very little understanding.)

Can this little girl’s life be better or worse than what it would have been if she were a “normal” child? (This is her normal, so it will be what she makes of it.)

The problem with all these questions is that no one can really know, but she must be allowed to learn and explore freely if she is to find even a modicum of happiness. Just ask me after a lifetime of hiding and denial.

GARY KNICKERBOCKER Kenosha, Wis., June 26, 2013

My daughter was born a boy but realized at a very young age (3, I think) that she was really a girl. My wife and I did not push her into being a girl. Just the opposite. I used to tell her that she was a boy and to stop dressing like a girl. She would get very angry at me and tell me that she was a girl.

I thought it was a phase. Nope. Not a phase.

I accept my daughter for who she is because she is my daughter and I love her. Isn’t that what parents are supposed to do?

Recently, my daughter had to switch schools because of a redistricting. She was now told that she was no longer allowed to use the girls’ bathroom but had to use the unisex bathroom. Why? The school was afraid that she would be outed by the other students because they were looking under the bathroom stalls. Instead of addressing the issue of privacy, it was deemed easier to treat my daughter differently.

My daughter is a girl who just happens to have boy body parts. But there is this fear of something different. I am afraid that one day I am going to get a call from the school telling me that my daughter was attacked for being different.

Transgender children do not want special privileges. They want to be treated equal. She wants to be treated like any 8-year-old girl. She wants to have crushes on boys, dance around the house when her favorite song comes on the radio and screech with delight when the prince saves the princess at the end of a fairy tale.

BRIAN SINGER Laurel, Md., June 26, 2013

Dr. Drescher’s letter should be helpful for those dealing with children who have gender identity “issues” by letting them know that at this time there is no right or wrong way for them to act. Society is mostly to blame for the children who are being made miserable.

When teaching classes in child development, I have asked the girls who had been called tomboys as kids to raise their hands. About a third of the females’ hands shot up, and they were happy to tell their stories of refusing to wear a dress, wanting to play only with boys, not liking to play with dolls and trying to urinate standing up.

Then I asked the boys in the class who had been called sissies to raise their hands. There was lots of laughter and no hands went up.

I had no way to know if the tomboys grew up to be gay or transgender, but we all can see that they are easily allowed by society to wait and see what happens as they grow to adulthood. The little girl dressed up for Halloween as a monster or superhero is seen as cute, but heaven help the little boy in a tiara.

As a parent I would reason that as the tomboys mostly outgrew their gender dysphoria, so would the sissies (and too bad we have no neutral word for these little boys). Letting the boys be princesses is as unlikely to cause them to be gay or transgender as is letting your daughter be Batman. How to get everyone else to accept this is another issue.

The writer is an associate professor of psychology at Brookdale Community College.

As the head of the longest-standing specialized gender identity clinic for children and adolescents in the world, I would like to applaud Dr. Drescher for his thoughtful letter. For those of us “in the trenches,” I can state unequivocally that specialized clinics, such as ours, are in the midst of a marked increase in referrals of both children and youth who are struggling with their gender identity. In the past decade, children and adolescents with gender dysphoria have come out of the closet at a rate that is rather astonishing.

Dr. Drescher has astutely pointed out that, at present, the best practice approach for treating young children with gender dysphoria is “up in the air.” The new early gender transition therapeutic approach stands in marked contrast to other therapeutic approaches in which efforts are made to help a child feel more comfortable with a gender identity that matches his or her birth sex, in part to avoid the complexities of lifelong cross-sex hormonal treatment and sex-reassignment surgery. My impression is that the early gender transition approach will result in more children persisting in their desire to live as a member of the other gender, which is, in effect, a rather interesting social experiment of nurture.

The field urgently needs comparative studies of the different therapeutic approaches that are currently in play and designed to help these children. Such studies will provide important information to the parents of these youngsters. In the final analysis, what is key is that we understand how to best help these youngsters achieve the best possible psychosocial adaptation vis-à-vis the developmental tasks and challenges of life, regardless of their long-term gender identity.

KENNETH J. ZUCKER Toronto, June 26, 2013

The writer was chairman of the D.S.M.-5 Work Group on Sexual and Gender Identity Disorders and is the head of the Gender Identity Service for children and adolescents at the Center for Addiction and Mental Health.

The Writer Responds

Mr. Fierstein is right. Most children don’t care which bathroom they use until they are trained to feel shame about crossing the gender divide. It is mostly adults who get worked up over the gender coding about who gets to use which bathroom.

I share Ms. Ladin’s concern that the actual needs of gender variant children may get obscured when they serve as proxies for a multiplicity of adult agendas. This can happen when parents and clinicians discourage gender variant behavior but also when some insist that early social transition is the treatment of choice.

Ms. Beyer correctly notes a solid empirical basis supporting transition in adults. Yet the same cannot be said about the child literature. And I share her and Ms. Ley’s concern for children whose childhood cross-gender interests are painfully discouraged. On the other hand, that does not answer the question of whether a young child permitted to transition gender role who then changes her mind can simply and harmlessly transition back to the natal gender.

Does it matter which child is hurt more? I believe that comparing forms of suffering is beside the point and sidesteps the issue of how to explain to parents what clinicians know and don’t know. And given that no one knows how any child’s gender will ultimately find expression, what is needed is more tolerance, less polemics and fewer opinions presented as hard facts.